ICU · GI/Nutrition
Intra-abdominal hypertension and abdominal compartment syndrome
Also known as Intra-abdominal hypertension (IAH) · Abdominal compartment syndrome (ACS) · Intra-abdominal pressure (IAP) · Abdominal perfusion pressure (APP) · Surgical decompression
Intra-abdominal hypertension (IAH) is sustained intra-abdominal pressure 12 mmHg. Abdominal compartment syndrome (ACS) is sustained IAP 20 mmHg with NEW ONSET organ failure (kidney, respiratory, cardiovascular). Causes: abdominal trauma/surgery, massive fluid resuscitation, pancreatitis, ileus, peritonitis, burns. Measurement: bladder pressure (gold standard). Effects of raised IAP: renal failure (venous congestion, reduced perfusion), respiratory failure (elevated diaphragm, reduced compliance, high ventilator pressures), cardiovascular (reduced venous return, reduced cardiac output), intestinal ischaemia, raised intracranial pressure. Treatment: decompressive laparotomy for ACS. Prevent: avoid excessive fluid resuscitation, nasogastric decompression, prokinetics.
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Red flags
- ACS = IAP >20 mmHg + new organ failure — surgical emergency. Decompressive laparotomy required
- Unexplained oliguria + high ventilator pressures + metabolic acidosis = measure bladder pressure
- Over-resuscitation with crystalloid is the #1 cause of secondary ACS — avoid excessive fluids
- Raised IAP increases intracranial pressure — important in TBI patients with abdominal injuries
Meet the patient
A 62-year-old man is in ICU on day 2 after an emergency open repair of a ruptured abdominal aortic aneurysm. He had 8 units of red cells, 6 of plasma, and 6 litres of crystalloid in theatre. Now he is oliguric at 8 mL an hour despite two doses of furosemide, his abdomen is tense, his peak airway pressure has climbed from 28 to 46 cmH2O, and his bladder pressure is 30 mmHg.[2][18]
Two questions decide his next hour, and they are the two that decide every case of suspected ACS: is the pressure over 20 with new organ failure? and have you, in chasing his blood pressure, made the compartment tighter? Hold those two and the management ladder below slots into place.[3]
References19ShowHide
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- [3]Nasa P, Chanchalani G, Juneja D, et al. Surgical decompression for the management of abdominal compartment syndrome with severe acute pancreatitis: A narrative review World J Gastrointest Surg, 2023.PMID 37901738
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